Key result
Protamine sulfate infusion can cause anaphylaxis and cardiovascular collapse, which may be managed with steroids, antihistamines, and methylene blue for refractory cases.
Why the study?
Little evidence guides the treatment and management of protamine sulfate anaphylactic reactions causing cardiovascular collapse.
Case Report
Highlights risk factors, diagnostic strategies, and management options for protamine sulfate-induced anaphylaxis and cardiovascular collapse.
May aid protamine anaphylaxis recognition in procedures; leaves open evidence-based management strategies.
Key Teaching Points•Risk factors for anaphylaxis to protamine sulfate include previous exposure to protamine, neutral protamine Hagedorn (NPH) insulin use, fish allergies, and previous vasectomy.•Protamine sulfate anaphylactic reactions can be distinguished from other acute causes of cardiac decompensation by the timing relative to protamine use, bedside echocardiography, laboratory evaluation, and electrocardiography.•Little evidence guides the treatment and management of protamine reactions. Pretreatment with steroids and antihistamines in high-risk patients and the use of methylene blue for refractory anaphylaxis are options for management. •Risk factors for anaphylaxis to protamine sulfate include previous exposure to protamine, neutral protamine Hagedorn (NPH) insulin use, fish allergies, and previous vasectomy.•Protamine sulfate anaphylactic reactions can be distinguished from other acute causes of cardiac decompensation by the timing relative to protamine use, bedside echocardiography, laboratory evaluation, and electrocardiography.•Little evidence guides the treatment and management of protamine reactions. Pretreatment with steroids and antihistamines in high-risk patients and the use of methylene blue for refractory anaphylaxis are options for management.
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Geurink et al. (2020) conducted a case report in Cardiovascular collapse following protamine sulfate infusion. Protamine sulfate was evaluated. Protamine sulfate infusion can cause anaphylaxis and cardiovascular collapse, which may be managed with steroids, antihistamines, and methylene blue for refractory cases.
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